CHEST Guidelines-Practice,-Outcomes,-and-Complications-of-Emergent-

Practice,-Outcomes,-and-Complications-of-Emergent-

Pdf Summary

The study "Practice, Outcomes, and Complications of Emergent Endotracheal Intubation by Critical Care Practitioners During the COVID-19 Pandemic" examines changes in emergency intubation practices, outcomes, and complications for COVID-19 patients compared to pre-pandemic critically ill patients. This retrospective analysis included 1,260 intubations at Montefiore Medical Center from July 2019 to May 2020, dividing patients into prepandemic and pandemic cohorts based on their admission dates concerning the onset of COVID-19.<br /><br />Key findings reveal that during the pandemic, video laryngoscopy and neuromuscular blocking agents were more frequently used (video laryngoscopy: 89.4% vs. 53.3%; neuromuscular blockade: 86.0% vs. 46.2%), leading to higher first-pass success rates (94.6% vs. 82.9%). However, this period also saw increased complication rates, particularly hypoxemia (25.7% vs. 8.2%).<br /><br />The research indicates that changes in practice, guided by pandemic-specific protocols aiming to minimize infection risk and improve procedural success, significantly altered outcomes. Despite improved first-pass success, the increase in complications highlights the severe hypoxemic states of patients with COVID-19 prior to intubation.<br /><br />The study underscores the potential permanent adoption of some pandemic practices like video laryngoscopy and neuromuscular blockade to enhance procedure success beyond COVID-19 cases, though highlights the need for further investigation due to its observational and retrospective nature. It further demonstrates the capability of trainees to achieve outcomes comparable to experienced clinicians under well-defined guidelines. Future research should focus on improving safety and reducing complications in emergent airway management for COVID-19 patients.

Keywords

emergent endotracheal intubation

COVID-19 pandemic

critical care practitioners

video laryngoscopy

neuromuscular blocking agents

first-pass success rates

hypoxemia complications

pandemic-specific protocols

Montefiore Medical Center

retrospective analysis